Veterans' Use of VA Whole Health Care Is Associated with Increased Completion of Psychotherapy for PTSD
BACKGROUND:
About two-thirds of Veterans who initiate evidence-based psychotherapy (EBP) for PTSD discontinue treatment before completing an adequate number of therapy sessions. This quality improvement study examined the relationship between VA Whole Health (WH) care—comprised of WH services (e.g., health coaching, wellness groups) and complementary and integrative health (CIH) therapies—and EBP completion (i.e., completing 8 EBP sessions within 14 weeks). The analytic cohort consisted of 100,177 Veterans with PTSD (76% male, 62% White, average age 47 years, 57% had co-occurring depression, 40% had a co-occurring anxiety disorder) who initiated EBP from FY2018–2022. Among those who initiated EBP, 9,824 (10%) had used WH services and 3,396 (4%) had used CIH therapies; Investigators controlled for demographic and health-related variables in their analyses.
FINDINGS:
- Use of Whole Health care at various points in the EBP treatment trajectory was associated with increased rates of EBP completion.
- Without concurrent use of any WH services, on average, 34% of Veterans completed an EBP. This increased to 38% among Veterans who used WH services and 40% among those who used CIH therapies at any time in the EBP treatment trajectory.
- Whole Health services were most strongly associated with PTSD EBP completion when received both before EBP initiation and concurrently with EBP.
- CIH therapies were most strongly associated with PTSD EBP completion when received concurrently with EBP or both before EBP initiation and concurrently with EBP.
IMPLICATIONS:
- As the Whole Health model of care continues to expand within VA, it has the potential to support healthcare for vulnerable Veteran populations and to promote sustained Veteran engagement in EBP for PTSD.
LIMITATIONS:
- The results of this evaluation do not prove causal relationships between WH care use and completion of EBP.
- Relatively few Veterans in the cohort used WH services and CIH therapies during the analytic timeframe.
AUTHOR/FUNDING INFORMATION:
This study was funded by VA’s Office of Patient-Centered Care and Cultural Transformation (OPCC&CT) and HSR’s Quality Enhancement Research Initiative (QUERI). Dr. Etingen is with the Dallas VA Medical Center. Drs. Coggeshall, Reed, Engel, Rosser, and Zeliadt and Ms. Hall Douglas are with HSR’s Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care. Drs. Hogan and Bokhour are with HSR’s Center for Health Optimization and Implementation Research (CHOIR).
Etingen B, Douglas JH, Coggeshall S, Reed DE II, Engel CC, Hogan TP, Rosser E, Bokhour BG, Zeliadt SB. Use of Whole Health Care is Associated with Increased Completion of Evidence-Based Psychotherapy for Posttraumatic Stress Disorder among Veterans Receiving Care within the Veterans Health Administration. Journal of Traumatic Stress. 2026 Feb;39(1):23-34.
